Provider Demographics
NPI:1083157325
Name:MALONE, GLORIA JIOVANI (COTA)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:JIOVANI
Last Name:MALONE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7945 DELTA POST DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6834
Mailing Address - Country:US
Mailing Address - Phone:904-955-6973
Mailing Address - Fax:
Practice Address - Street 1:7945 DELTA POST DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6834
Practice Address - Country:US
Practice Address - Phone:904-955-6973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118008224Z00000X
FL15508224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant